Working in the postnatal wellbeing field, one of the most common questions I get from new mums is this:
What type of postnatal exercise is safe for me, and what exercises should I avoid?
It’s a difficult question to answer in a blog post – because the answer will be different for each woman. What is and isn’t considered to be safe will depend on several factors, such as the woman’s level of fitness before and during pregnancy, the type of birth she had (vaginal or Caesarean), whether she had a traumatic birth, or perhaps an episiotomy or perineal tear, how well her pelvic floor is restoring to full function, whether she has an abdominal separation (diastasis recti) and how severe it is, how much rest she’s currently getting at the time, whether she had significant blood loss during labour which might have affected her iron levels….
The list goes on and on, because the factors are very diverse, which is why in my clinic I always undertake a detailed initial assessment for each new Mum who comes to see me for rehabilitation.
But I know this isn’t possible for everyone, so I’ve put together a list of the five most important moves for new mothers to avoid.
When looking at this list it’s important to remember that these restrictions aren’t FOREVER! I know some women might see the list and become frustrated or demotivated, but please remember that by sticking to the guidelines now, you’re likely to recover from your pregnancy and delivery much quicker, which will enable you to get back to the fun stuff a lot sooner – and with less ongoing problems (such as embarrassing leakage issues in Body Attack!)
So the following moves are best avoided for the first several weeks (or months) until such time that you are fully healed from pelvic floor issues, diastasis recti, back pain, and C-section surgery. Remember that every woman heals at a different rate, so to be really sure you should seek advice and support from a women’s health OT, women’s health physio, or a fitness trainer with excellent training in postnatal wellbeing.
The top five types of exercises for new mothers to AVOID
Exercises that put lots of strain on the belly – such as crunches, sit ups, or double leg lifts. These all increase the “intra-abdominal pressure” in the torso, and can worsen an abdominal separation or increase pelvic floor dysfunction.
Sit ups aren’t the only way to work those abs!
High impact activities
Running, jumping, bouncing on a trampoline, jumping jacks, burpees, box jumps, skipping, Body Attack classes. These also put increased pressure on the pelvic floor musculature, which can lead to or worsen incontinence.
Box jumps can be too high impact for many postnatal women.
Heavy overhead work
Such as lifting heavy weights over your head – again can result in increased intra-abdominal pressure, plus, if you don’t have good core control – which is common post pregnancy due to weakened abdominals, there is a danger of lower back injury.
Weight training is great for postnatal women, but it should be modified for each individual’s needs.
Moves where your legs stretch apart from each other at speed
Splits, sumo squats, skiing type movements, mountain climbers, jumping jacks, kickboxing – place additional strain on your pelvic floor muscles and ligaments
Save the star jumps and interpretive dance for a few months down the track.
Moves where your belly is hanging down – such as planks. Now this is a bit of a controversial one, as lots of new mums and trainers like to use planks, because they know they shouldn’t be doing sit ups (see point 1!). But it’s best to use caution with planks early on, and to make sure that if you’re going to do them, that you’re able to properly engage your abdominal muscles, to prevent poor form and potential back pain.
Planks are great – but make sure your core is ready for them.
Right, so what CAN I do??
Well firstly, remember, these guidelines are only to be in place until you’re HEALED! So please don’t fret, or get impatient! It’s best to grade your workouts down a notch for a few months to make sure you heal fully, and start gradually building back up. Please don’t jump back in full-bore, and risk exacerbating a condition that hadn’t quite healed, or creating a brand new problem.
Things that are great in the early months (after six week check up) include:
Walking : Seriously this is the best – on your own, with a friend, or grab the pram and take bubs around the block – use good form and walk mindfully – don’t just stroll, really think about your stride, your posture and your breathing. Keep upright, shoulders back and down, core “on” while walking – especially when pushing a pram!
Pilates: My absolute favourite – you can choose from mat or equipment classes –Just make sure you let your instructor know you are postnatal. Everything in Pilates can be modified or replaced, so if your instructor doesn’t alter any exercises for you, think about how much knowledge they have – don’t be afraid to ASK them about what post-natal training they’ve done! Mums and Bubs classes are great as they are tailored for post-natal women.
Yoga – another great low impact option. Again, let your instructor know you are postnatal, be gentle with your body and don’t push too far into any pose. Remember you may still have some amounts of relaxin running through your body, which keeps your ligaments more prone to over-stretching. Also, avoid hot or bikram yoga if you’re still breastfeeding.
Weights – weights are a fantastic way to build strength and fitness back up after baby, they’re also a great way to address potential muscle imbalances that arise in new Mums. It’s best to avoid group classes until you’re healed and I recommend booking some one to one sessions with a trainer to check your form and set up a program if you’re not familiar with weight training.
Finally, a word on instructors and group fitness classes:
As I mentioned earlier in the article, don’t assume your instructor or trainer has any knowledge about working with postnatal clients. There are so many amazing trainers out there. But unfortunately many of them don’t have specialised training in working with pregnant and postnatal clients. There’s a lot happening in the postnatal body, and recovery can often take a lot longer than we think it will. There’s also a lot going on ‘inside’ our body that we can’t see, which we should be mindful of when it comes time to get back to exercise. So always ask your trainer what postnatal training and qualifications they have, and ask them to talk about how they will adapt a program for you. If you’re not happy with their response – find another trainer! You only get one body, so make sure you find someone who’s going to help you look after it!
Also, let’s just chat about group fitness classes. Quite often group classes will have up to 30 – or even more – people in the class. So it’s difficult for a trainer (even one who knows you are postnatal) to watch you carefully and remind you of all the modifications. So there’s a lot of responsibility on the postnatal woman (ie. You!) to make sure you know your restrictions when it comes to these classes, which often feature lots of the movements I mentioned above. Also, be particularly cautious of energy in group classes. When something is super fun and inspiring, it can be quite easy to get “dragged along with the crowd” and attempt moves that are outside of your comfort zone, or to feel like you’re not doing enough and want to measure up to everyone else.
My final piece of advice…
Just be patient, take these first few months to really get to know and respect your body, and do the right thing by it. Trust me – your body will thank you for it down the track – and hopefully never let your pelvic floor fail during Body Attack!
Until next time, keep well.
Cheers, Sarah xx
ps. If you’d like to know more about how best to regain strength and function while recovering from pregnancy and childbirth, check out my Body Mind Baby online postnatal wellbeing program, our next program begins on May 2. Register before April 22 to take advantage of our early bird pricing – just $117 down from $147.
How long did it take you to “recover” after you had your babies? Was it six weeks? Six months? A year? When we talk about “post-natal recovery” there’s an awful lot we need to consider.
I read with interest this article from the Daily Mail in UK, which suggested that post-natal recovery timeframes are actually closer to 12 months, a lot more than generic 6 week time frame that is so often bandied about.
I think the issue here is with the definition of “post-natal recovery” – because in my opinion, there’s a lot more to it than simply waiting for your episiotomy wound to heal.
Of course, there’s the “physical recovery” – pelvic floor function and rehab, repairing any abdominal separation (diastasis recti), regaining your core strength and returning your body to a better posture and alignment, addressing any back, neck and shoulder complaints you may have from pregnancy or constantly lifting and carrying your baby, plus whatever other physical issues may have cropped up for you. This is all really important if we want our bodies to be functional for the next 60 odd years, and to not be reliant on incontinence pads in our 40s.
When did you feel “back to normal”?
Then there’s the “emotional recovery” – adjusting to the role of motherhood and all the feelings that come along with it: fear, anxiety, bewilderment, helplessness, overwhelm, concern, failure, confusion, anger, loss, and guilt that can go along with this. Not to say that all our emotions are negative. There’s also love, joy, passion, gratitude, purpose, connection, fulfilment, and so much more. But you know what – these emotions can be overwhelming too – and it can take us a while to settle into these new feelings and emotions as well.
And what about the “social recovery” which I think is often forgotten, but which can be really challenging for so many women. Adjusting to changed relationships – with your husband or partner, your friends, your own mother. Adjusting to no longer being a worker or bringing in an income. Navigating the maze of postnatal and baby services and making new friends. Redefining who you “really are” now that your a Mum. Feeling like you’ve lost your own identity. Feeling trapped or unable to escape. There’s a lot that happens in the social front – these are all challenges and women often need support to adjust to these changes.
So bearing all of that in mind – how long would you expect it to take to “recover” from childbirth? It’s an intensely personal experience, and it’s about so much more than whether or not you’re “all healed down there”. Some women bounce back from childbirth straight away – both physically and emotionally. Others may take longer to sort through the emotional challenges, others may not notice the physical challenges until after they have their second baby. Some might not notice issues until they decide to go back to work, or until their children start school.
It’s not a precise science, and there’s a lot of factors to consider. But for the majority of women, their postnatal “recovery” continues much longer than their 6 week post baby check up!
Here’s my top five tips for supporting your postnatal recovery:
1) Realise that postnatal recovery involves a LOT of different factors
It’s so much more than just losing the baby bump. I mentioned all the factors above that have an impact on how well we “bounce back” after birth. Take a few minutes to review those areas of your life, and then give yourself a little credit for ALL the adjustments you’re currently dealing with. There’s always more happening than meets the eye – wellbeing involves a lot of different factors.
2) Give yourself time – aka: Please, please, please don’t set yourself deadlines.
I posted on facebook recently about this US Runner who was back training for Olympic trials five weeks after childbirth, despite having a significant abdominal separation and lots of incontinence issues. As a professional athlete, this woman makes her living through running, she’s on a tight timeline when it comes to Olympic trials, and she also has a huge team of health professionals supporting her in her rehab. I’m hopeful she’ll make a full recovery at some point. But I wonder how much faster she might have healed her abdominal separation and pelvic floor issues if she’d had the time to recover properly – without loading her body up with a heavy running schedule while simultaneously trying to rehab. Most of us aren’t professional athletes, so there’s no hard and fast timeline for us to have to recover from.
3) Know what’s “normal” and what’s just common in the postnatal period
There’s a big difference between “common” – as in it happens to lots of new mothers, and what’s “normal” as in what’s the way something “should” be. Some postnatal concerns can be uncomfortable or embarrassing – such as incontinence. And in the rush to make women feel better about these embarrassing conditions we’re quick to reassure them it’s “totally normal, nothing to worry about!” But this does women a huge disservice. Labeling something as “normal”, when it actually isn’t, means that women may think these things are what “should” happen to new mothers, and therefore not seek help to address it. Let’s recognise that issues such as postnatal incontinence, abdominal separation and back pain are “common”, very, very common in fact – but they’re not normal – it’s not how the human body is designed to be. And we can work to address these issues – we just need to be aware that we CAN. #commonnotnormal
4) Get the right professional support
One of my clients last week told me she was considering changing her personal trainer. She’s not 100 percent happy with his level of knowledge on what is and isn’t suitable for postnatal and pregnant women, and after having a few back pain twinges recently, so she’s reconsidering whether he’s the right fit for her. Working with pregnant and postnatal clients requires a detailed understanding of female anatomy, and an excellent knowledge of what is and isn’t appropriate for this group. Make sure you find health professionals (whether it be your physio, personal trainer, or group fitness instructor) who has additional training in pregnancy and postnatal care. Even the best trainer in the world can unintentionally cause damage if they don’t have training in this field.
5) Do the work!
Okay, I admit it. Postnatal rehab can be boooooring! There’s a lot of breathing, a lot of checking your posture and alignment, a lot of repeating the same several exercises with perfect form. I know it can be boring. But it’s effective. It does the job – if you do yours! Rehab only works when the rehabber puts in the yards to do what their therapist asks them. This is true for postnatal women, professional footballers or injured workers. People who follow their rehab programs properly will always recover better than those who don’t. Rehab may not have the same level of exhilaration as an early morning run, or a Body Attack class with your bestie, but those things will always be there. In six weeks, or 12 months, they will still be there. But if you don’t do the work now – if you don’t take the time to make rehab a priority, what might also be there in 12 months is incontinence or abdominal separation – and the long term implications aren’t that much fun. Do the work. It will be worth it, I promise.
What has been your experience? I’m always keen to hear from my readers, so shoot me an email to firstname.lastname@example.org if you have any queries or comments.
Until next time, keep well and take the time to rehab properly!
ps. If you’d like to know more about rehab for motherhood, make sure to check out my Core Floor Restore five week online program. It’s chock full of information about abdominal separation, pelvic floor dysfunction, posture and alignment, back and neck pain, and it’s been specifically created for Mums to support their own understanding of their recovery and wellbeing. Click here to check out the Core Floor Restore program details and pricing.
Did you know that up to 65 percent of post-natal women will experience lower back pain in the 18 months after giving birth?
Or that 45 percent of all post-natal women will experience incontinence within seven years of pregnancy?
What about the fact that 10 percent of women who experience pelvic girdle pain during pregnancy will continue to have persistent pain for two years or more following delivery?
What do these stats tell us? That post-natal injury is normal, right?
No – it just tells us that it’s common. But common does not necessarily mean normal.
What I’m talking about here is not just an issue of semantics. It’s more an issue of acceptance, attitudes and belief.
The post-natal period is an extremely vulnerable one for many women – both emotionally and physically. During this time our bodies are recovering from the enormous strain which has been placed on them over the past 40 weeks or so. I’m not just referring to the struggle to get our flat tummy back (mine was never flat to start with!). What I’m talking about is restoring our posture and alignment after several months of having a changed centre of gravity. Allowing our joints, muscles, tendons and ligaments to return to their pre-natal state after being stretched, pulled and pressurised in so many different ways to accommodate our growing baby and our changing body structure. Allowing our hormonal balance to be restored.
This all takes time (did you know it can take up to 500 days for some tissues to fully heal?), and often the body can’t do it on its own. This is when we have the potential to develop what appears to be a chronic injury.
Because it happens so often, society just accepts it as “normal”.
“Oh you’ve got back pain – yeah, that’s just normal after having a baby.”
I say don’t use the word “normal”.
My mission through my private practice and this blog is to encourage women to challenge this notion that postnatal injuries are “normal”. By giving them this label, we are subconsciously telling women that they should just expect these injuries to occur – “It happens to everyone, just get used to it and get on with life.”
Back pain is common – but that doesn’t mean you have to accept it as normal!
Last year during my post-graduate studies I completed a literature review on the incidence of soft tissue injuries among post-natal women. One of the more concerning themes that emerged in my research was the often dismissive nature regarding these injuries – both from the women themselves and also from their treating health professionals. Issues such as back pain, pelvic pain and diastasis recti (abdominal separation) were often considered to be “normal” post-pregnancy states which would eventually improve spontaneously given time – therefore they sometimes weren’t given proper consideration or treatment early in the pre-natal period. This belief is a concern to me. It tells me that health professionals need to be proactive in the physical rehabilitation of post-natal women. Not only to provide early-intervention treatment or referral to other practitioners, but also to educate women on the difference between “common” and “normal” post-natal injury and recovery.
For the vast majority of situations, these injuries can be addressed, overcome and even prevented – with the right support, treatment and advice.
So please, if you are struggling with one of these conditions and have been told – “don’t worry, it’s just normal, it’ll go away eventually”. Don’t accept that. Demand a treatment option. Seek a different practitioner. Find a qualified Women’s Health Occupational Therapist, Women’s Health Physiotherapist, or Women’s Health trained Pilates Instructor.
If you want to work with me here in Adelaide, you can undertake my one to one OT Core Restore program,
Or if you’re from anywhere else around the globe, you can join my five week online Core Floor Restore postnatal wellbeing program.
Addressing injuries early and appropriately will speed up your healing and recovery time. And that will mean you can get back to “normal” much sooner.
Until next time,
ps. Just in case you want the references:
Gustafsson, J. & Nilsson-Wikmar, L. (2007). Influence of specific muscle training on pain, activity limitation and kinesiophobia in women with back pain post-partum – A ‘Single subject research design’. Physiotherapy Research International, 13(1), 18-30. doi: 10.1002/pri.379
Lee, D.G., Lee, L.J. & McLaughlin, L. (2008). Stability, continence and breathing: the role of fascia following pregnancy and delivery. Journal of Bodywork & Movement Therapies, 12(4), 333-348.
Vermani, E., Mittal, R. & Weeks, A. (2009). Pelvic Girdle Pain and Low Back Pain in Pregnancy: A Review. Pain Practice, 10(1), 60-71.